Document Detail


Outcome of less invasive proximal arch replacement with moderate hypothermic circulatory arrest followed by aggressive rapid re-warming in emergency surgery for type A acute aortic dissection.
MedLine Citation:
PMID:  19047777     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The mid-term outcome of quick proximal arch replacement with moderate hypothermia followed by aggressive rapid re-warming in emergency surgery for type A acute aortic dissection (AAD) was assessed. METHODS AND RESULTS: Eighty-five patients were divided into 2 groups: group I consisted of 43 patients undergoing surgery for deep hypothermic circulatory arrest and selective cerebral perfusion; and group II consisted of 42 patients who recently underwent aggressive rapid re-warming. During open distal anastomosis in group II patients with a rectal temperature of 28 degrees C but who did not suffer any cerebral perfusion, circulating blood in the cardiopulmonary bypass (CPB) circuit was warmed to 40 degrees C. As soon as distal anastomosis was completed, rapid re-warming was initiated by a 40 degrees C blood perfusion. The duration of CPB (I: 182.1 vs II: 85.3 min), overall operation (305.0 vs 150.8 min), postoperative mechanical ventilation (44.3 vs 9.1 h), and hospital stay (31.4 vs 9.6 days) were significantly shorter in group II patients. The incidence of postoperative brain complication (I: 14.0 vs II: 2.4%), renal failure (14.0 vs 0%), pneumonia (18.6 vs 4.8%), and mortality (9.3 vs 0%) was significantly less in group II patients. CONCLUSIONS: Moderate hypothermia followed by a rapid re-warming procedure was safe and effective in the proximal arch replacement for AAD.
Authors:
Mitsumasa Hata; Mitsunori Suzuki; Akira Sezai; Tetsuya Niino; Isamu Yoshitake; Satoshi Unosawa; Kazuma Shimura; Kazutomo Minami
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-12-02
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  73     ISSN:  1346-9843     ISO Abbreviation:  Circ. J.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-26     Completed Date:  2009-04-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  69-72     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. mihata@med.nihon-u.ne.jp
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical / methods
Aneurysm, Dissecting / surgery*
Aorta, Thoracic / surgery*
Aortic Aneurysm / surgery*
Cardiovascular Surgical Procedures / adverse effects,  methods*
Circulatory Arrest, Deep Hypothermia Induced* / adverse effects
Female
Humans
Male
Middle Aged
Retrospective Studies
Rewarming* / adverse effects
Surgical Procedures, Minimally Invasive / adverse effects,  methods*
Treatment Outcome

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